Gynecologic oncology最新文献

{"title":"Comparative efficacy and safety of low-dose versus high-dose bevacizumab in ovarian cancer: An indirect treatment comparison","authors":"Josée-Lyne Ethier ,&nbsp;Cal Shephard ,&nbsp;Diana P. Granados ,&nbsp;Nikkita Dutta ,&nbsp;Rana Qadeer ,&nbsp;Saima Ahmad ,&nbsp;Ellen Kasireddy ,&nbsp;Mir-Masoud Pourrahmat ,&nbsp;Mir Sohail Fazeli","doi":"10.1016/j.ygyno.2025.03.022","DOIUrl":"10.1016/j.ygyno.2025.03.022","url":null,"abstract":"<div><h3>Objective</h3><div>First-line therapy for ovarian cancer involves cytoreductive surgery and platinum-based chemotherapy, with or without bevacizumab. Bevacizumab can be administered at low (7.5 mg/kg every three weeks [Q3W]) or high dose (15 mg/kg Q3W). This study compared the efficacy and safety of these dosing strategies.</div></div><div><h3>Methods</h3><div>Systematic literature review of Embase, MEDLINE®, and CENTRAL (18/09/2023) identified randomized controlled trials (RCTs) evaluating bevacizumab versus any therapy or control in ovarian, fallopian tube, or primary peritoneal cancer. Indirect treatment comparisons (ITC) of response, survival, and safety outcomes were performed, including sensitivity/subgroup analyses adjusting for heterogeneity.</div></div><div><h3>Results</h3><div>Six RCTs (sample size: 24–1528 patients) were included for ITC. Five evaluated high-dose bevacizumab with chemotherapy. The common comparator was carboplatin + paclitaxel. Trials mainly included stage III (<em>n</em> = 4) or stage II-III (<em>n</em> = 1) ovarian cancer patients; one did not report cancer stage. Primary analyses showed no significant differences between low- versus high-dose bevacizumab for partial response (risk ratio [95 % confidence interval]: 0.66 [0.42, 1.02]), complete response (1.76 [0.76, 4.11]), objective response rate (1.01 [0.63, 1.61]), progressive disease (1.08 [0.38, 3.10]), clinical benefit (0.89 [0.76, 1.03]), any grade ≥ 3 adverse event (1.53 [0.96, 2.44]), specific grade ≥ 3 adverse events, overall survival (hazard ratio: 0.93 [0.77, 1.13]), or progression-free survival (1.02 [0.86, 1.22]). Sensitivity and subgroup analyses confirmed findings.</div></div><div><h3>Conclusions</h3><div>This ITC found no significant difference in clinical outcomes between low- and high-dose bevacizumab combination therapy. Despite limitations of small sample size and heterogeneities, findings suggest that bevacizumab dose may not significantly impact ovarian cancer outcomes.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 1-9"},"PeriodicalIF":4.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient outcomes in advanced ovarian cancer treated with an anti-FOLR1 antibody–drug conjugate","authors":"Paul Johannet ,&nbsp;Matthew Flint ,&nbsp;M. Herman Chui ,&nbsp;Jason Konner ,&nbsp;Claire Friedman ,&nbsp;Angela K. Green ,&nbsp;Robin Guo ,&nbsp;Martee L. Hensley ,&nbsp;Chrisann Kyi ,&nbsp;Ying Liu ,&nbsp;Vicky Makker ,&nbsp;Maria Rubinstein ,&nbsp;Paul Sabbatini ,&nbsp;William P. Tew ,&nbsp;Michael B. Foote ,&nbsp;Britta Weigelt ,&nbsp;Carol Aghajanian ,&nbsp;Rachel N. Grisham ,&nbsp;Roisin E. O’Cearbhaill","doi":"10.1016/j.ygyno.2025.03.023","DOIUrl":"10.1016/j.ygyno.2025.03.023","url":null,"abstract":"<div><h3>Background</h3><div>Mirvetuximab soravtansine-gynx (MIRV) is a FOLR1-binding antibody–drug conjugate (ADC) with a microtubule inhibitor payload. We investigated MIRV's efficacy, toxicity profile, and determinants of resistance in a cohort of patients with recurrent/persistent high FOLR1-expressing high-grade serous ovarian cancer (HGSOC).</div></div><div><h3>Methods</h3><div>This retrospective study included 170 patients with recurrent/persistent FOLR1-high (≥75 % of tumor cells with ≥2+ membranous staining intensity) HGSOC who received standard-of-care MIRV monotherapy. We evaluated progression-free survival (PFS) and overall survival (OS) using the Kaplan-Meier method and multivariable Cox proportional hazards models. We classified adverse events using CTCAE v5.0.</div></div><div><h3>Results</h3><div>Overall, median PFS was 3.5 months (95 % CI, 3.0–4.1). However, 22.4 % had PFS ≥6 months and were less likely to have progressed on or within one month of prior taxane-based therapy (<em>P</em> = 0.008). Patients with previous progression on a taxane had worse PFS (HR, 1.69; 95 % CI, 1.19–2.40; <em>P =</em> 0.003) and OS (HR, 2.34; 95 % CI, 1.45–3.77; adjusted <em>P =</em> 0.0005). FOLR1 expression was lower in post-MIRV samples (<em>n</em> = 12; <em>P =</em> 0.005). New or worsening neuropathy was observed in 37.6 % of patients. Among the 34.1 % who experienced ocular toxicity, median onset was 42.5 days. Treatment was discontinued in 5.3 % of patients due to toxicity.</div></div><div><h3>Discussion</h3><div>MIRV confers meaningful PFS benefit for a subset of individuals with HGSOC. Resistance may be associated with decreased FOLR1 target expression or payload resistance. FOLR1-targeted ADCs with a different payload should be evaluated for patients who progress on MIRV but retain high tumor FOLR1 expression.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 173-179"},"PeriodicalIF":4.5,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and therapeutic advances for HER2-expressing or amplified gynecologic cancers","authors":"Elizabeth K. Lee ,&nbsp;David L. Kolin ,&nbsp;Ursula A. Matulonis ,&nbsp;Britt K. Erickson","doi":"10.1016/j.ygyno.2025.03.011","DOIUrl":"10.1016/j.ygyno.2025.03.011","url":null,"abstract":"<div><div>HER2-targeting therapies are well-described in breast, gastric, and lung cancers, however accumulating data supports a role for HER2-targeted therapies in gynecologic cancers. Despite varied methodologies for HER2 testing, evidence supports that a substantial proportion of endometrial, ovarian, cervical, and vulvar cancers overexpress HER2. This underscores the rationale for HER2-targeted therapies in these malignancies, including the use of HER2-directed tyrosine kinase inhibitors, antibody-drug conjugates, and immune-stimulating antibody conjugates. Understanding mechanisms of resistance to HER2-targeted therapies will inform possible combinatorial strategies.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 152-164"},"PeriodicalIF":4.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of an ovarian cancer risk assessment tool for first-degree relatives of patients in the Chinese population","authors":"Yuan Li ,&nbsp;Manqi Wu ,&nbsp;Qiyu Liu ,&nbsp;Cuiyu Huang ,&nbsp;Yiming Fan ,&nbsp;Mengyang Wang ,&nbsp;Yikun Jin ,&nbsp;Liyuan Tao ,&nbsp;Xielan Yang ,&nbsp;Hongyan Guo","doi":"10.1016/j.ygyno.2025.03.017","DOIUrl":"10.1016/j.ygyno.2025.03.017","url":null,"abstract":"<div><h3>Objective</h3><div>To develop and validate an ovarian cancer risk assessment tool for first-degree relatives of patients in the Chinese population.</div></div><div><h3>Methods</h3><div>A bidirectional multicenter cohort was established, including 529 probands and 3141 first-degree relatives. Cancer incidence was analyzed using the standardized incidence ratio (SIR). Significant variables were identified through Cox regression analyses and visualized via a nomogram. Model performance was evaluated using the C-index, with first-degree relatives stratified into high- and low-risk groups based on a 10 % cancer risk threshold.</div></div><div><h3>Results</h3><div>Among 1596 first-degree female relatives, 57 ovarian cancer cases were identified, demonstrating a significant increase in SIR (SIR = 9.19; 95 % CI, 7.03–11.83; <em>p</em> &lt; 0.001). In 980 relatives with germline mutations, elevated SIRs were observed for ovarian cancer (SIR = 23.33; 95 % CI, 16.51–32.09; <em>p</em> &lt; 0.001) and breast cancer (SIR = 3.56; 95 % CI, 2.46–5.00; p &lt; 0.001). Cox regression analyses identified key risk factors, including the proband's age of onset, tumor histology, gene mutation status, family history of breast cancer, and relationship to the proband. The nomogram demonstrated good predictive accuracy, with C-indices of 0.75 (training set), 0.75 (internal validation), and 0.71 (external validation). Calibration plots and Kaplan-Meier curves confirmed strong agreement and significant differences between high- and low-risk groups (cut-off value = 2.1).</div></div><div><h3>Conclusions</h3><div>This study develops and preliminarily validates a risk assessment tool for first-degree relatives of ovarian cancer patients in China, utilizing accessible clinical and familial data to enable early identification of high-risk individuals.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 165-172"},"PeriodicalIF":4.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometrial cancer somatic testing practice patterns among gynecologic oncologists","authors":"J.A. DeMari ,&nbsp;D. Glassman ,&nbsp;S. Smith ,&nbsp;J.P. Darby ,&nbsp;E.V. Dressler ,&nbsp;K.E. Weaver ,&nbsp;C.M. Cosgrove","doi":"10.1016/j.ygyno.2025.03.020","DOIUrl":"10.1016/j.ygyno.2025.03.020","url":null,"abstract":"","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 149-151"},"PeriodicalIF":4.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaplastic carcinoma of the ovary: A single-institution experience and molecular analysis","authors":"Mackenzie W. Sullivan ,&nbsp;M. Herman Chui ,&nbsp;Pier Selenica ,&nbsp;Kara Long Roche ,&nbsp;Yukio Sonoda ,&nbsp;Rachel N. Grisham ,&nbsp;Chrisann Kyi ,&nbsp;Amir Momeni-Boroujeni ,&nbsp;Nadeem R. Abu-Rustum ,&nbsp;Britta Weigelt ,&nbsp;Roisin E. O'Cearbhaill","doi":"10.1016/j.ygyno.2025.03.021","DOIUrl":"10.1016/j.ygyno.2025.03.021","url":null,"abstract":"<div><h3>Objective</h3><div>We describe a tertiary referral center's experience with anaplastic ovarian carcinoma and characterize the genetic landscape of these rare tumors.</div></div><div><h3>Methods</h3><div>Anaplastic ovarian carcinomas were retrospectively identified from institutional databases from 2013 to 2023. Clinical data and survival outcomes were abstracted from the electronic medical record. Molecular data were obtained from clinical tumor-normal panel sequencing.</div></div><div><h3>Results</h3><div>Thirteen tumors were identified; 12 (92 %) were associated with or arose from a mucinous carcinoma, and 6 (46 %) were found in a mural nodule. Median age at diagnosis was 39 years (range, 19–77); 6 patients had stage I disease (3 stage IA), 1 had stage II, 5 had stage III, and 1 had stage IV. All patients underwent surgery. First-line postoperative therapy included carboplatin-paclitaxel doublet (<em>n</em> = 8), a 5-fluorouracil-oxaliplatin-based regimen (FOLFOX, <em>n</em> = 1; XELOX, <em>n</em> = 2), and ifosfamide/paclitaxel (n = 1). Two patients did not receive adjuvant chemotherapy for early-stage disease. Six patients had progression or recurrence; 5 had platinum-refractory disease and 1 had an initial progression-free interval of 6.8 months. For the 7 patients without recurrence, median follow-up was 79.7 months. Median overall survival for all patients was 28.1 months (range, 7.8–139.2). Five patients died of their disease. Ten patients had clinical panel sequencing, revealing recurrent somatic <em>KRAS</em> G12D/V hotspot mutations (8 of 10, 80 %) and genetic alterations affecting cell cycle-related genes, including <em>TP53</em> (6 of 10, 60 %) and <em>CDKN2A</em> (6 of 10, 60 %).</div></div><div><h3>Conclusions</h3><div>Anaplastic ovarian carcinoma is characterized by <em>KRAS</em>, <em>TP53</em>, and <em>CDKN2A</em> alterations. Novel treatment approaches are needed due to the high rate of platinum-refractory disease.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 144-148"},"PeriodicalIF":4.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validating the predicted impact of HPV vaccination on HPV prevalence, cervical lesions, and cervical cancer: A systematic review of population level data and modelling studies","authors":"Daniël de Bondt ,&nbsp;Emi Naslazi ,&nbsp;Erik Jansen ,&nbsp;Rachel Kupets ,&nbsp;Bronwen McCurdy ,&nbsp;Christine Stogios ,&nbsp;Inge de Kok ,&nbsp;Jan Hontelez","doi":"10.1016/j.ygyno.2025.03.008","DOIUrl":"10.1016/j.ygyno.2025.03.008","url":null,"abstract":"<div><h3>Background</h3><div>We compared model predictions with independently published primary data from population-based studies on the impact of HPV vaccination on HPV prevalence, cervical cancer and its precursors.</div></div><div><h3>Methods</h3><div>We searched Cochrane Library, EMBASE, MEDLINE, Web of Science for studies concerning high-income countries published between 2005 to June 2, 2023. Relative risk (RR) for HPV-related outcomes comparing the pre-vaccination and post-vaccination periods were collected from observational and modelling studies. The relationship between vaccination coverage and observed relative reductions was determined using meta-regressions, and we compared model prediction to observations.</div></div><div><h3>Findings</h3><div>We identified a total of 5649 potential articles, of which one systematic review, 14 observational studies and 32 modelling studies met our inclusion criteria. A clear relation was found between the RR of HPV diseases related outcomes in the pre- versus post-vaccination era and the vaccination coverage, with 23 out of 28 data points and 19 out of 20 data points showing significant reductions in HPV prevalence and CIN2+ prevalence respectively. Around 67 % (n/<em>N</em> = 12/18) of model predictions were more optimistic on HPV prevalence reductions compared to the 95 % CI of the meta-regression derived from observational studies. For CIN2+ lesions, 48 % (n/<em>N</em> = 31/64) of model predictions for CIN2+ outcomes fell within the 95 % CI.</div></div><div><h3>Interpretation</h3><div>Model predictions and observational data agree that HPV vaccination can have a substantial impact on HPV related outcomes on a population level. Despite large heterogeneity in observational data and modelling studies, it is particularly encouraging that model predictions on the impact of HPV vaccination on CIN2+ model lesions align with observational studies.</div></div><div><h3>Funding</h3><div>Ontario Health (formerly known as Cancer Care Ontario).</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 134-143"},"PeriodicalIF":4.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143641839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporation of triapine (T) to cisplatin chemoradiation (CRT) for locally advanced cervical and vaginal cancer: Results from NRG-GY006, a phase III randomized trial","authors":"Charles A. Leath III ,&nbsp;Wei Deng ,&nbsp;Loren K. Mell ,&nbsp;Debra L. Richardson ,&nbsp;Joan L. Walker ,&nbsp;Laura L. Holman ,&nbsp;Jayanthi S. Lea ,&nbsp;Sudha R. Amarnath ,&nbsp;Luis Javier Santos-Reyes ,&nbsp;Rebecca C. Arend ,&nbsp;Jyoti Mayadev ,&nbsp;Naresh Jegadeesh ,&nbsp;Paul DiSilvestro ,&nbsp;Hye Sook Chon ,&nbsp;Sharad A. Ghamande ,&nbsp;Lei Gao ,&nbsp;Kevin Albuquerque ,&nbsp;Junzo P. Chino ,&nbsp;Eric Donnelly ,&nbsp;Jonathan M. Feddock ,&nbsp;Bradley J. Monk","doi":"10.1016/j.ygyno.2025.03.007","DOIUrl":"10.1016/j.ygyno.2025.03.007","url":null,"abstract":"<div><h3>Background</h3><div>Cisplatin-based chemoradiation (CRT) plus brachytherapy for locally advanced cervical cancer (LACC) is standard. Intrinsic overexpression of ribonucleotide reductase (RNR) may enhance DNA damage repair from CRT. We report on outcomes of adding RNR inhibitor, triapine (T), to CRT.</div></div><div><h3>Methods</h3><div>NRG-GY006 is an open-label randomized phase III trial. FIGO 2009 LACC (stages IB2, II, IIIB or IVA) without para-aortic nodal involvement or stages II-IV vaginal cancer were eligible. Random assignment to CRT or in combination with thrice-weekly T (CRT + T) occurred. Radiation consisted of either 3D conformal (3DCRT) or image-guided intensity modulated RT (IG-IMRT) followed by intracavitary brachytherapy. Primary endpoint was overall survival (OS). Progression-free survival (PFS) was secondary. Exploratory endpoints included complete metabolic response rate on post treatment PET/CT imaging and comparative toxicity and outcomes for 3DCRT vs. IG-IMRT.</div></div><div><h3>Findings</h3><div>Four-hundred-fifty patients were randomized including 448 eligible (224 in CRT and 224 in CRT + T). Median age was 47 (range 23–85). The majority had cervical cancer (93.3 %) with squamous histology (82 %). 52 % had FIGO stage II disease. Racial/ethnic distribution included non-Hispanic white (53.8 %), black (15.2 %) and Hispanic/Latina (22.5 %). At randomization, IG-IMRT was planned in 74.3 % and HDR brachytherapy in 98.2 %. No differences in Grade 3–5 toxicities were observed: CRT: 52 % and CRT + T: 49 %, with two G5 toxicities (cardiac arrest and acidosis) in the CRT + T arm. The median patient follow-up was 28 months (IQR 15–45). HR for death was 1.018 (95 % CI 0.634–1.635) while HR for progression was 1.021 (95 % CI 0.694–1.501).</div></div><div><h3>Interpretation</h3><div>Triapine added to CRT did not improve OS.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 122-133"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143641957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive outcomes after premenopausal risk-reducing Salpingo-oophorectomy: The role of hormone therapy.","authors":"Mei Zhao, Lianwei Xu","doi":"10.1016/j.ygyno.2025.03.014","DOIUrl":"https://doi.org/10.1016/j.ygyno.2025.03.014","url":null,"abstract":"","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial/ethnic, socioeconomic, and healthcare access disparities in achieving textbook oncologic outcome in advanced ovarian cancer","authors":"Giuseppe Caruso ,&nbsp;Amanika Kumar ,&nbsp;Carrie L. Langstraat ,&nbsp;Michaela E. McGree ,&nbsp;Angela J. Fought ,&nbsp;Shariska Harrington ,&nbsp;Dimitrios Nasioudis ,&nbsp;Giovanni D. Aletti ,&nbsp;Nicoletta Colombo ,&nbsp;Robert L. Giuntoli ,&nbsp;William Cliby","doi":"10.1016/j.ygyno.2025.03.016","DOIUrl":"10.1016/j.ygyno.2025.03.016","url":null,"abstract":"<div><h3>Objective</h3><div>Textbook Oncologic Outcome (TOO) is a composite measure that strongly predicts survival after surgery for advanced epithelial ovarian cancer (AEOC), regardless of approach: primary (PDS) or interval debulking surgery (IDS). We aimed to identify risk factors associated with failure to achieve TOO and to receive standard treatment (surgery and chemotherapy) for AEOC.</div></div><div><h3>Methods</h3><div>Patients diagnosed with AEOC between 2008 and 2019 were identified using the National Cancer Database. TOO was defined as achieving complete cytoreduction, hospital stay &lt;10 days, no 30-day readmission, adjuvant chemotherapy initiation &lt;42 days, and 90-day survival. Logistic regression models were used to identify factors associated with TOO and receipt of standard treatment.</div></div><div><h3>Results</h3><div>Among 58,635 AEOC patients, 49% received standard treatment. Of the 21,657 patients who underwent surgery, 51.4% received PDS and 48.6% IDS. For PDS multivariable analysis, factors associated with lower likelihood to achieve TOO included age &gt;75 years (vs &lt;60; OR 0.47, 95% CI 0.38–0.58), Black race (vs White; OR 0.73, 95% CI 0.59–0.90), government insurance (vs private; OR 0.82, 95% CI 0.73–0.92), high surgical complexity (vs low; OR 0.62, 95% CI 0.56–0.68), and median surgical volume ≤5 cases/year (vs ≥20; OR 0.75, 95% CI 0.63–0.89). For IDS, similar associations were observed for government insurance (OR 0.87, 95% CI, 0.80–0.96), high surgical complexity (OR 0.61, 95% CI 0.55–0.66), and median surgical volume ≤5 cases/year (OR 0.60, 95% CI 0.52–0.70).</div></div><div><h3>Conclusions</h3><div>Several factors are associated with lower likelihood of achieving TOO after treatment for AEOC. Some of these factors (age, race, payor type) reflect disparities in care; others (facility volume, surgical complexity) highlight the need for referral to high-volume centers for initial treatment planning.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 106-114"},"PeriodicalIF":4.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}